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VLCAD

It’s been a week…

Personal, Uncategorized, VLCAD

I barely had a chance to get used to the idea that Oliver wasn’t with us anymore when Lila started running a fever and my focus had to change. By Friday night she was sick to her stomach (huge red flags for FOAD kids!), and despite her insistence that she was okay, I called the metabolic specialist who suggested we take her to the hospital for fluids.

VLCAD sucks. I’m just going to come out and say it. Preventative, multi-night hospital stays with a 3 year old sucks. Begging and pleading with your kid to just please eat so we can go home really sucks. It’s draining.

She ended up being diagnosed with influenza in the ER. Having my dad experience serious complications from the flu 4 years ago has imprinted on me how serious the flu can be. We get our flu shots every year, but hadn’t gotten ours yet this year. Luckily Lila’s symptoms were mild and any other kid would have been fine managing at home with the symptoms she had. But, because of her VLCAD diagnosis she needed to get on some extra fluids until she could eat again. The thing is, she is just not herself in the hospital, so I walk this tight rope of begging to take her home to see if she will eat vs. staying in the hospital for multiple days with a kid who is totally fine but just doesn’t want to eat because being in the hospital is one of the worst things ever!

On top of that, there was a labour strike within the school system which meant schools were closed and kids were supposed to be doing online work. My husband is a mechanic and this is a busy time for him (plus he just recently started this job), and truth be told, we really need the income that his job brings in right now. Me not working the way I normally would during the pandemic really took its toll on us. So I felt like I was in this no-win position…

Thankfully, we ended up getting the ok to go home on Sunday afternoon which was amazing. However, by Monday I was sick, and then on Tuesday my oldest fell sick. And let me tell you, influenza is not a joke. I scream this from the roof tops every year after seeing what my dad went through, “get your dang flu shot!” We had it mild and it’s still pretty awful. Plus, it could save a kid like Lila from spending days in the hospital.

But now, Thursday, Isabel is on the mend. I am feeling about 75% better and at least able to stay conscious for an entire work day.

It just feels like a lot sometimes. Life should only be allowed to dole you out one thing at a time. At this point, I’m not sure if I’m exhausted from fighting this virus or the emotional toll it all takes. In typical “Me” fashion, I chalk it up to me being somehow lazy and find a way to beat myself up about it.

I really struggle with Lila’s VLCAD diagnosis sometimes. We are fortunate that she has never had any symptoms and the two times she has been hospitalized, all of her bloodwork came back normal. But that throws you for a different loop as a parent. You have, on paper and what appears to be a “well” child who you are forcing to get an IV and blood draws and sit in an ER room for several hours. She was so freaked out after the IV that she wouldn’t even let anyone take her temperature under her arm. I’m still somehow hopeful that genetics will come back one day and find that her genetic mutations, both of which haven’t been seen before in any other VLCAD case, is actually benign. I don’t know if this is just me still being in denial because she always looks so well, or if there actually is hope. Regardless, I do all the things I’m supposed to… but I do worry sometimes that we are over treating her and making her scared of going to see doctors…

What I do know is that if I hear one more medical professional tell me. “All you have to do is feed her every 3 hours,” or “Just make sure she has juice when she’s sick,” I may just implode. Have you ever tried to “just” feed a toddler every 3 hours? or an infant? if they don’t want to eat, there is really no forcing them, but you as the parent have it in your head that if they don’t eat, the results could be deadly. There is no “just” doing anything with a toddler. There is not “just” a trip to the hospital for fluids. It’s an ordeal. Toddlers have this amazing way of making everything epic, for better or for worse!

When I explain the protocols for Lila’s illness to people it never sounds that bad, but it can really be an emotional challenge. While we were in the hospital, I pulled out her medical file that we carry everywhere in case she is hospitalized… in it, I had records of all of her feeds when she was an infant. Every 2-3 hours around the clock. I remember being so stressed when she wouldn’t eat after 3 hours, fearing that she would go into a metabolic crisis. And now, if she is sick and won’t eat every 3 hours, or worse, if she’s sick to her stomach, I get all of those same feelings. It’s hard trying to understand an illness as rare and complex as VLCAD. I don’t know if I need to be as stressed as I am about Lila… I hear mixed messages. From our doctors I hear she is “very mild.” And yet that doesn’t change her illness management. From the FOAD community, many of whom have lost children to these disorders will say there is no such thing as mild FOAD; that they can all lead to metabolic crisis. I’ll hear “all she needs is some fluids when she’s sick and to eat a heart healthy diet.” But what that actually looks like is much more complex (at this time in our lives anyway).

I’m eager for the day when Lila can tell me more clearly what is going on with her body and how she is feeling, and when she can understand why she needs to be eating and drinking. But at this time, it’s a struggle. I always am hesitant to share these feelings because I often get brushed off by people saying, “well at least she is well,” or “it could be worse.” And of course it could. But it also doesn’t mean that this doesn’t come without it’s challenges too, and I wish that could be acknowledged sometimes.

I’m going to leave on a high note. Here are my kiddos in their handmade halloween costume. One Yoshi and one zombie cat (which was harder to make than Yoshi)!

Welcome to the World, Lila-Jean!

Baby, Personal, VLCAD

Little Lila-Jean arrived on the evening of July 4th! I received a call from my doctor who had some concerns (too complicated for me, not a doctor, to explain), and gave me the option of having my water broken to induce labour. I was a little nervous to do this, but decided it was the best option for the safety of my little one. So, Dan and I headed into the hospital and Isabel and the dogs went for a sleepover at my parents house. My water was broken around 6pm, just after 9 I was holding a beautiful little baby girl in my arms! It was a very quick birth, no time for an epidural, and way, way, way, WAY more painful than I remembered, but thankfully my lady-parts survived unscathed, and I was surprised to be feeling pretty amazing by the next day!

Lila was born quickly and needed a little bit of oxygen after she was born, but otherwise looked perfect as can be. She has been a pretty chill baby since day one. She took easily to breastfeeding, she settles to sleep fairly easily (other than last night! Growth spurt time), and is a total little doll.

One day old.

Everything seemed to be going swimmingly with the new baby. Isabel was adjusting nicely, and we were all starting to settle in, when we received a call from the Hospital for Sick Kids in Toronto… Every baby born is offered newborn testing for 29 (I believe) treatable illnesses. Lila screened positive for one I had never even heard of; VLCAD.

We had to head to Toronto bright and early the next day to have more testing done. I was feeling hopeful that she would come back not having this disorder. There was no history of it in our families as far as we knew and she seemed totally normal and healthy!

Lila had some blood drawn and then we waited the entire day in the lobby of Sick Kids, which is not a fun way to spend a day with a newborn… Around 5 we finally got the news we were afraid of… Lila does seem to have VLCAD, though her blood work shows that she may have a mild case. We were sent down to the emergency room to be admitted so we could start her on a special formula, and have her monitored over night.

As we were waiting in the ER to be admitted, I was given a bottle with Lila’s new formula in it. Up until this point, she had been exclusively breastfed, but she seemed to be doing ok with the bottle… that is until I noticed it was flowing a little too fast for her. I pulled the bottle away and went to burp her when she went completely limp and unresponsive. When you’re at sick kids, in the ER with an unresponsive infant the medical response is… quick and dramatic. We were rushed into a room where she was placed on a table, hooked to an IV and other monitoring equipment. She quickly regained consciousness, but it was the most terrifying moments of my life. I need to say, the staff at the hospital were all amazing, but that day was a very traumatic experience. Not only was I still hormonal after having only given birth a week or so prior, sleep deprived and dealing with the shock of an unexpected diagnosis, my baby… my brand new baby went floppy and unconscious before my eyes. They determined that the episode was likely unrelated to her VLCAD diagnosis, and most likely she “choked” (my word) on the formula. She’s been totally fine ever since, but it was so incredibly scary.

I’m not even going to try to explain VLCAD in my own words, so I’ll quote from the newborn screening website:

Very long-chain acyl-CoA dehydrogenase deficiency (VLCAD) is a rare, inherited (genetic) disease.
Babies with VLCAD cannot make certain fats into energy, especially during long periods without food (fasting).
Babies can get very sick if they cannot make fats into energy when needed.
Without treatment, minor illnesses and fasting can cause life-threatening episodes called metabolic crises.

We just recently got the results of Lila’s enzyme test which shows she does have the ability to breakdown some very long chain fats, but not entirely. The metabolic team we are working with consider her case mild, which I am so incredibly grateful for. We are still waiting for more genetic testing to be done to get more specific information.

There is no “cure” for VLCAD, but the treatment in our case is fairly simple on the surface. We just have to feed her every 2-3 hours (and we just go the ok to let her sleep 4 hours overnight between feeds). The tricky part is that we have to combination feed. She gets a small bottle of special formula, then breastfeeds. She tends to feel full-ish after a bottle so waits a bit before breastfeeding, so I often feel like I’m just feeding her around the clock. We have to keep a chart of all of her feeds. If she gets sick and can’t eat or keep food down, we have to take her to the hospital for iv fluids.

This diagnosis and the trips to Sick Kids has really taken a lot out of us. When she first was tested, we had to treat her as though she had a severe form of the illness… just in case! It all seemed so very serious. And it has the potential to be, but it is much more manageable than we had thought. As Lila gets older, she will be able to go longer and longer between meals. She will grow up a totally normal kid. We just will have to be cautious when she is sick, and make sure she has a snack before being active.

The world of metabolic disorders is all so new to me. We are so incredibly fortunate to be able to work with the metabolic team at Sick Kids in Toronto. They are absolutely amazing.

So… As you can see, it’s been a pretty hectic month. But, I feel like we’re starting to settle into a bit of a routine these days. I’m getting accustomed to the feeding schedule and juggling two kids (and two dogs… honestly the dogs are more work). Lila is seriously an amazing baby, she makes it pretty easy. And Isabel is such a helpful big sister, I’m not sure where I’d be without her… and Dan. Dan is in charge of formula and making sure I wake up to feed her at night and staying calm when I am losing it and assuring me everything will be fine.

Sisters.

To add just a little bit of extra drama to our already scary month, last Friday as I was walking into the house with the two girls, I tripped on a loose board on our walkway and fell while carrying Lila in her carseat. Isabel immediately freaked out because I had spilled the contents of the diaper bag. I freaked out because I had dropped my 3 week old baby, and Lila mostly just sat there and looked perplexed. Falling with a newborn, whether she’s buckled into a care seat or not, is pretty much the worst thing ever. She seemed totally ok, but I didn’t want to risk it. I took her into the after hours clinic near our house to get her checked out and of course she was totally fine… This visit made me realize though, that I need to be an expert on Lila’s condition. I mentioned to the doctor (who was amazing!) that she has VLCAD, and I had to explain it to her the best I could. No slight against the doctor of course, there is a reason why doctors specialize. It just was a reminder for me that what we are dealing with is rare and I have to make sure I am well educated so I can advocate for the best care for her.

And before you ask, yes, I am also ok! A little bruised, but Isabel fixed me up with some Finding Nemo bandaids.

I’m hoping that we got all of our drama out of the way in July and can now settle down into a boring, event free August. I have a couple of patterns that I am eager to work on and release soon – my nursing bra expansion pack as well as maternity undies. I also just realized I never released a couple of my harness/vest patterns… I had hoped to get back to taking some lingerie orders sooner rather than later, but with the insanity of the last month I’m going to give myself some time to rest before getting back to work…